Form DEPLW1999-21
Maine Department of Environmental Protection
Waste Discharge Permit Application
Publicly Owned Treatment Facilities
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This form must be attached to the General Application for a Waste Discharge Permit
Please answer all questions completely, using additional pages as necessary with responses clearly identified by item number on this form.
1. Facility Name: ______NPDES # ME ______
2. Wastewater treatment facilities for normal (or dry weather) flows.
A.) Please show below or attach a line drawing showing all treatment units and important associated or supporting units.
B.) What is the design capacity of treatment facility in MGD?
Monthly Average ______Daily Maximum _____ Peak Rate ______
3. Wastewater treatment facilities for storm water flows.
A.) Please show below or attach a line drawing with all treatment units or operating practices used for storm water flows above the capacity of the facilities used for normal flows.
B.) What is the design capacity in MGD? Daily maximum ______Peak Rate ______
C.) What is the frequency of high flows? ______
D.) Does the facility have a high flow management plan? ______
If so, date of last revision ______
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Application for Publicly Owned Treatment Facilities
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4. Wastewater collection system.
A.) List below all Combined Sewer Overflow points in the system, even if inactive.
Number / Name / Location / Receiving WaterB.) Describe any significant problems or issues with the collection system that affect the wastewater treatment facility operation or effluent quality.
5. Septage and other wastes received. (See Chapter 555 of the Department’s rules.)
A.) Gallons of septage currently authorized. Monthly total ______; Daily maximum ______
B.) Gallons of septage requested for future. Monthly total ______; Daily maximum ______
C.) Describe current and/or proposed septage receiving and treatment facilities. Please attach the management plan for these facilities, per Chapter 555, Section 6.
D.) Are other wastes received by truck or other dedicated conveyance? _____ If so, describe.
6. Industrial contributions. Include only process and other non-domestic wastes.
A.) Process wastes from categorical users. See appendix A for a list of categorical industries.
Source / Type of wastes / Pretreated? / Average volume and strengthB.) Other significant (non-categorical) sources of process wastes.
Source / Type of wastes / Pretreated? / Average volume and strengthC.) Other miscellaneous wastes such as rinse waters, cooling waters, etc.
Source / Nature of waste / Average volume and strength7. Effluent toxicity testing
A.) Please list the dates of Whole Effluent Toxicity and Priority Pollutant screening and surveillance tests previously submitted under Chapter 530.5 during the last five years.
Date / Whole Effluent Toxicity done? / Priority Pollutant Scan done?B.) Please attach the results of additional effluent toxicity testing done but not reported as part of the tests listed above or the requirements of discharge permit limitations.
8. Facility modifications or improvements. Please include reference to plans, studies or reports done in support of these changes as appropriate.
A.) Describe modifications and improvements that have been completed since the previous permit issuance or reissuance.
B.) Describe modifications or improvements being planned or under consideration, including proposed implementation schedules.
9. Facility operations.
A.) Describe significant operational issues, upsets and problems that have been encountered during the past two years.
B.) Describe any proposed changes to the present facility operation.
10. Person completing this form
Name: ______Phone: ______
Affiliation: ______Date: ______
Appendix A. List of Primary Industrial Categories
Adhesives and sealants / Aluminum formingAuto and other laundries / Battery manufacturing
Coal mining / Coil coating
Copper forming / Electrical and electronic components
Electroplating / Explosives manufacturing
Foundries / Gum and wood chemicals
Inorganic chemicals manufacturing / Iron and steel manufacturing
Leather tanning and finishing / Mechanical products manufacturing
Nonferrous metals manufacturing / Ore mining
Organic chemicals manufacturing / Paint and ink formulation
Pesticides / Petroleum refining
Pharmaceutical preparations / Photographic equipment and supplies
Plastics processing / Plastic and synthetic materials manufacturing
Porcelain enameling / Printing and publishing
Pulp and paper mills / Rubber processing
Soap and detergent manufacturing / Steam electric power plants
Textile mills / Timber products processing
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